New ADAI Research: Community-Based Medications First for Opioid Use Disorder
09/20/2024
Citation: Banta-Green CJ, Owens MD, Williams JR, Floyd AS, Williams-Gilbert W, Kingston S. Community-based medications first for opioid use disorder – Care utilization and mortality outcomes. Substance Abuse and Rehabilitation 2024;15:173-183.
The most effective and evidence-based treatments for opioid use disorder (OUD) are medications for OUD (MOUD) like buprenorphine, methadone, and extended-release injectable naltrexone.
However, though most people with OUD want to stop or reduce their use of opioids and are interested in taking MOUD, they often have a difficult time engaging in MOUD at opioid treatment programs and traditional health care settings.
To help address this challenge, Dr. Caleb Banta-Green and colleagues tested the impacts of a community-based “medications first” model of care in 6 Washington State communities that provided low-barrier, drop-in MOUD access.
Participants in the study included over 800 people newly prescribed MOUD and able to access the study sites, located at a range of harm reduction and homeless services programs. The goal was to provide care where people with OUD already receive other services and often have an established and trusting relationship with staff and volunteers.
The community-based medications first (CBMF) intervention offers:
- rapid (typically same-day) access to medications
- convenient, non-appointment-based care
- no exclusions for polysubstance use
- no counseling requirements (but services readily available)
- ongoing, easy-to-access care.
Researchers compared study participants with a comparison group and found that folks in the CBMF program had significant increases for days’ supply of buprenorphine, months with any MOUD, and months with any buprenorphine for people previously on buprenorphine.
Months with an emergency department overdose did not change, however there was a significant increase in inpatient hospital stays.
Importantly, CBMF participants also had a lower annual death rate compared to the comparison group: just 0.45% (3 out of 664) for the CBMF group compared to 2.2% (222 out of 9893) for the comparison group.
Conclusions: Participants in the study who received the community-based medications first intervention had more access to and use of MOUD and a lower mortality rate compared to the comparison group. The COVID-19 epidemic and rapid increase in non-pharmaceutical fentanyl may have lessened the intervention’s impact as measured in this analysis, however this study supports expanding access to a third model of low barrier MOUD care alongside opioid treatment programs and traditional health care settings.
“We’re particularly encouraged by these strong findings, which, while expected for MOUD in general, are very important to see in the low-barrier care settings where we worked and a highly marginalized population that was served,” said Dr. Banta-Green. “We’re tremendously grateful to the study participants and to the amazing participating sites across WA state for their phenomenal work on a challenging health care issue and during a time of immense challenges during the public health crisis see with COVID-19 and the emergency of non-pharmaceutical fentanyls.”
Read the full article here (free!) | Watch Dr. Banta-Green explain the study in this short video
